What's the best cure, Dr Google?

If you've ever wanted to track an influenza outbreak as the cold, wet winter months roll by, try asking Google instead of the health department. At the first sign of a sniffle, people now regularly turn to the web for a diagnosis and treatment, giving the search engine the ability to monitor the spread of the virus through such simple techniques as someone entering the words "flu symptoms".
It's just one of the ways the internet is changing the delivery and management of health care and it's not just about patients haranguing their doctors with information they gleaned online.

Instead, clinicians are increasingly integrating consumer technologies such as the web, mobile phones and home computers into health services as they seek a more detailed picture of a patient's ailments. It's a trend that's also giving millions of Australians the ability to manage their health more actively and it's one that researcher Judy Proudfoot says will only grow in influence.

"We are taking more responsibility for our health and it's good if people find out about their health beforehand and check it out with the clinician as and when they need to," Proudfoot says. "I see it being a healthy aspect, a very proactive aspect of the whole approach to health seeking, health management and health care.

Proudfoot, a senior research fellow at Black Dog Institute and at the University of NSW's School of Psychiatry, has helped develop mobile phone and internet systems designed to aid sufferers of mental illnesses in managing their conditions.

She says research from the Australian Bureau of Statistics has shown that one in five Australians experience a mental health condition each year, but that few seek assistance due to a variety of reasons, such as geographic remoteness or a fear of the stigma sometimes attached to mental illness.

In October, Black Dog will launch an SMS and web service that will give depression sufferers the ability to track and document symptoms electronically and receive alerts about their illness.

The tracker platform Proudfoot describes is a digital variation on the diaries clinicians have long urged mentally ill patients to maintain.

She says it has the potential to prevent hundreds of thousands of people with mild problems from developing more serious conditions.

"The great advantage as far as mental health services are concerned is that people do have their mobile phones with them all the time, and with many mental health conditions . . . the most important thing is to start to monitor symptoms," she explains.

"It's very much about the person being their own care giver and in control of their own management of their health."

The attitude is one that a host of mainstream information technology companies have embraced in recent years through the release of products that allow consumers to manage their personal health information.

David Dembo leads Microsoft's health business in Australia. He says most households have a family health manager, mum in most cases. She is generally the one who takes responsibility for medication management, scheduling appointments and keeping the health records for the whole family.

Those efforts are completely disconnected from the health system today but, with hospitals perennially suffering from staff shortages, Dembo sees a growing role for the family health manager.

Microsoft's response to that is a system called HealthVault, which lets people collect, store and share personal medical information such as prescription information and test results with family members or, more importantly, doctors. Google Health has launched a similar internet platform, although neither its nor Microsoft's is officially available in Australia.

Australians can, however, access the Microsoft and Google platforms, although clinicians have warned that information is stored offshore and that could expose local patients to less stringent privacy controls than they are used to.

Some health care workers also argue that clinicians won't put the same stock in personally maintained electronic health records as they would in information stored in a government-run system.

The chairman of the Royal Australian College of General Practitioners quality care committee, Ron Tomlins, is one of those with concerns.

He regularly provides patients with web pages from the Victorian government's Better Health Channel because of the quality of information that's available. He is not a fan of the idea that patients should keep their own health records up to date through online platforms provided by companies like Google or Microsoft.

"If you're relying on people to put information into a health record after a consultation then there's a very significant likelihood that they will not get it right," Tomlins argues.

"Studies over many years have shown that people retain less than 10 per cent of what they're told in a consultation; less than 1 per cent of anything that comes after the word 'cancer'. And there are privacy concerns.

To be perfectly honest, there's no way I'd allow my records to be in the hands of Microsoft or Google."

Other systems designed to help consumers better manage their health are intended for use in concert with clinicians. One is Intel's Health Guide, an electronic device that allows doctors to manage patient care remotely.

Intel has announced a $US250 million research and development partnership with $US17 billion health technology player General Electric to develop such systems.

Intel's guide began US trials last year and allows users to undergo a variety of medical tests from home. It will be available only through health-care providers.

Australian hospital software maker IBA Health has built a technology platform that will help patients stay in touch with medical professionals after they leave hospital or their doctor's surgery.

Three area health services in Shanghai are now using the platform for inter-hospital communications and the next stage is to broaden the scope of the project, known as Fusion, by making it public. High-speed broadband is widely available in Shanghai and IBA already broadcasts medical information via an internet TV health channel.

By plugging a webcam into a modified set-top box, residents will be able to turn their TVs into videoconferencing units. IBA intends to introduce a service in the months ahead where users can schedule a video meeting with their doctor through their TV's remote control.

Researchers such as Proudfoot note that the rise of consumer-managed health technologies is changing the nature of relationships between clinicians and patients. She says the flow of information between them is becoming more dynamic, but adds that it's important to allow patients independence when it comes to managing their care.

"The role [of clinicians] is changing as well in terms of where people get support for mental health conditions. I see that as being due not only to the availability of high-quality information on the internet, but also high-quality therapeutic programs and other services on the internet too," Proudfoot says.

"If you're going to use [Black Dog's] internet programs and mobile tracker programs with a clinician, then the internet and the mobile programs become a therapeutic tool. That's one way of using our programs, but they also stand alone." Fairfax Business Media

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